As vaccine rollout has accelerated across the country, all 50 states have met President Biden's goal of opening vaccination eligibility to all adults by April 19. While an age-agnostic approach theoretically opens the door for communities of color, which tend to be younger, increased eligibility means more competition for a still limited supply. This puts the most vulnerable at renewed risk of being left behind.
As a result, stakeholders need to remain focused on equitable distribution. WellSpan Health, an integrated health system that serves the communities of central Pennsylvania and northern Maryland, realized that while vaccine education is an important component of building public confidence in the vaccine, education alone can't fix long-held distrust or structural access barriers—or ultimately reduce inequities.
To move the dial, WellSpan's efforts to improve equitable access embed trust-building into distribution and directly address structural barriers to access. Read on to learn how.
3 ways WellSpan builds trust to overcome structural access barriers
1. Value qualitative community input as much as quantitative analysis to uncover community needs and design strategies to address them.
Understanding the severity of Covid-19 disparities, WellSpan leaders aimed to administer an equitable vaccine rollout—their goal was to distribute a minimum of 10% of their total vaccine allotment to at-risk populations via dedicated outreach programs. To meet the goal, leaders prioritized vulnerable communities (within their state-mandated priority groups) for proactive outreach using a Covid-19 risk score. It was developed by analyzing EHR data to identify patients' age, race, ethnicity, and comorbidities associated with significant risk for Covid-19. WellSpan then partnered with community-based organizations to reach out to these individuals to encourage them to sign up for the vaccine. Because the outreach came from trusted community leaders, patients were more likely to accept the vaccine.
But leaders recognized that proactive outreach alone wouldn't be enough to ensure vulnerable communities could access the vaccine. To learn more about community needs, WellSpan held more than 35 community listening sessions to understand patients' perceptions and concerns about Covid-19 vaccines. Many sessions included a bilingual physician to communicate with non-English speaking patients, which enabled WellSpan to surface concerns from a diverse patient set. These strategies unearthed themes of trust, fear, and access barriers, which became the groundwork for WellSpan's strategy.
2. Meet patients where they are with a decentralized distribution model that locates vaccination sites at highly frequented community sites.
Since WellSpan's patient population is distributed across multiple regions, leaders recognized that having one centralized vaccination clinic would not support vaccine accessibility—especially if some patients lacked sufficient transportation to reach a centralized site. To expand access, WellSpan developed community vaccine distribution sites across five regions at familiar locations to the community, including low-income housing sites and local nonprofits like the YMCA.
3. Conduct proactive screening for transportation needs at registration that pairs patients with a continuum of supplemental support.
At the point of scheduling, WellSpan asks patients about their ability to get to their appointment, including whether they have sufficient transportation. When patients screen positive for transportation needs, WellSpan pairs patients with transportation services or home-based vaccinations using its mobile clinic.
The mobile Covid-19 vaccine clinic is staffed by community paramedics and vaccinators who go directly to patients' homes to administer the vaccine. Once the mobile clinic team is at the home, they take the opportunity to vaccinate other individuals at the residence who meet the current phase criteria. Currently, the teams primarily travel to low-income high-rise senior centers and senior day care centers, where Covid-19 risk is concentrated. Next, WellSpan plans to expand the mobile vaccine clinic's reach to rural communities.
Notably, these initiatives aren't static—WellSpan uses real time data tracking to flag when disparities crop up and develop proactive strategies to address them. But one underlying theme is clear: regardless of specific strategy, trust-building is essential for vaccine rollout success.